Individual
DR. RANDALL BRUCKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3711 ROME DRIVE, SUITE A, LAFAYETTE, IN 47905
(765) 742-3100
(765) 742-0152
Mailing address
1741 CUNNINGHAM ROAD, SPEEDWAY, IN 46224
(765) 742-3100
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12010142
IN
Other
Enumeration date
05/08/2007
Last updated
07/24/2007
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